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From the moment a patient is on the operating table to when the operation is complete, the surgical team is under constant pressure. If something happens and the patient’s life is in danger, it’s the Intraoperative Critical Event Team that’s called in to help at Moffitt Cancer Center.

Of the more than 12,800 surgeries performed at Moffitt every year, there’s an average of fewer than six critical events. Dr. Jennifer Perone, a complex general surgical oncology fellow, recently presented research on “Evaluation of an Intraoperative Critical Event Team at a Major Cancer Center.” Here she shares more about Moffitt’s ICE Team.

1. What is an Intraoperative Critical Event?
An intraoperative or procedural critical event is when something happens during surgery or a procedure that puts the patient at immediate risk of death or serious morbidity. The most common scenario involves acute bleeding that is difficult to control.

2. What is the difference between ICE and Intraoperative teams?
The regular intraoperative team is the primary surgical team that is performing the elective operation or procedure (typically a surgeon, fellow or assistant, circulating nurse, scrub tech and anesthesia). The ICE team is designed to be an emergency response team for acute issues that may arise during a planned operation. The ICE Team is composed of surgeons who are immediately available in the operating room to respond in an emergency. They are senior surgeons who can identify and help manage intraoperative complications. 

3. What are the roles and responsibilities of the ICE Team?
There are many people involved in an ICE event. The first is the primary OR team. The operating surgeon is responsible for asking the circulating nurse to call the ICE surgeon or vascular surgeon (who comes from Tampa General Hospital) to activate the massive transfusion protocol. The OR nurse calls the requested personnel, and the anesthesia team also calls for backup from the other anesthesiologists. For the immediate response team, the primary person is the ICE Surgeon on call. This is a senior surgeon who is already in the OR operating that day, and three to five such surgeons are on ICE call every day. This person immediately responds to ICE events to help control the acute issue (again, most commonly this is bleeding). In addition to the ICE surgeon, activating this mechanism also recruits additional anesthesiology personnel (to help get additional IV access, start fluids, get blood ready, etc.), as well as additional nursing staff to make sure there are multiple people to get supplies as quickly as possible. 

Management of the patient and team post-ICE events is also very important, and this phase can involve the surgical, anesthesia, and nursing teams, as well as the chaplains.

4. Does the ICE Team operate on all types of surgeries?
Yes. The ICE team is there to help in an emergency. It’s basically an available surgeon to help get out of trouble or help fix the problem or control things while more assistance (such as a vascular surgeon) comes. The ICE team will respond to any operation from any surgical service, such as gastrointestinal surgery, gynecology, urology, neurosurgery, etc. 

5. Is there anything specific you’d like to share about the ICE Team?
It’s really designed for specialty hospitals like Moffitt that don’t have vascular surgeons or trauma surgeons in-house unlike what might be found at a general hospital. It’s a way to know that there is assistance for surgeons if they need it and that assistance is available within 10 minutes or so (as opposed to waiting for their partner to get out of the clinic, come down to the OR and change into scrubs, which can take 30-60 minutes). It also provides a protocol to help get additional assistance into the OR when needed. At its core, the ICE team provides backup for surgeons, which helps improve outcomes for patients and improves the well-being of staff. At Moffitt, there have been 11 ICE events in two years, and all 11 patients survived. It is not common to have ICE events, but when they do happen, it’s nice to know there is help available.